Examining Role Drift Among Personal Support Workers in Ontario

Transcription

1 DRIFTING OFF COURSE: Examining Role Drift Among Personal Support Workers in Ontario Authored by: Kyle Collins, Taylor Hogan & Mike Piwkowski 1 Drifting Off Course Collins, Hogan & Piwkowski

2 Acknowledgements This project owes a debt of gratitude to Dan Phillips, Jeff Cole, Karen McDonald, the Program Coordinators at the Georgian College PSW Program and the PSNO for their assistance in helping us to conduct this research. Thank you all very much for your support and kindness throughout the project. 2 Drifting Off Course Collins, Hogan & Piwkowski

3 Executive Summary Background Personal Support Workers (PSWs) are being called upon more heavily to help reduce health care costs and meet the needs of health recipients. Unfortunately, this increasing reliance on PSWs has resulted in the downloading of tasks from Registered Nurses (RNs) and Registered Practical Nurses (RPNs) onto PSWs. This trend is referred to as role drift. Due to a lack of training standardization and loose regulations governing the PSW profession, this shifting of tasks is of paramount concern to ensure quality care is provided by PSWs to care recipients. Purpose and Objectives The purpose of the study is to explore the occurrence, extent and awareness of role drift among Georgian College PSW students and PSWs employed in Ontario. Objectives: Build a demographic profile of Georgian College PSW students and professional PSWs. Determine what motivates PSW students to enroll in Georgian College over other education institutions. Explore the level of awareness and concern PSW students and professionals have in regards to role drift. Determine the frequency PSWs carry out tasks and the level of comfort PSWs associate with those tasks. Determine potential educational gaps and recommendations for improvement. Methodology and Sampling A two-phase approach was employed for the research conducted. Phase 1 attempted to gather PSW student feedback at Georgian College pertaining to their awareness of role drift and opinions concerning role drift related issues. Phase 2 attempted to gather PSW professionals opinions on role drift and current trends in the PSW profession. Key Findings Students Program/College Reputation and Distance are the most important factors influencing PSW student enrollment at Georgian College. A strong majority of students are aware of the trend of role drift (79%). Students are only moderately concerned about role drift (32%). However, students are uncomfortable performing tasks untrained (85%). Students are well informed about regulations. 95% of students responded that their teachers have (or will) taught the Regulated Health Professions Act. 3 Drifting Off Course Collins, Hogan & Piwkowski

4 Key Findings Professionals Role drift is occurring, but it is difficult to ascertain to what extent. Professionals are performing tasks outside their traditional roles but the research did not determine if they were performing these tasks untrained or unsupervised. PSWs are comfortable with most tasks they perform, particularly traditional PSW tasks. They are less comfortable with tasks outside their traditional role, but these tasks are performed infrequently. PSWs strongly express a desire for additional training. PSWs are concerned with the lack of professional standardization, unpredictable schedules, and the heavy workload they face on the job. Recommendations Georgian College PSW Program Look beyond a one-size-fits-all approach to program promotion. Emphasize the reputation of the Program/College to prospective students in Barrie and Muskoka, and close distance to students at other satellite campuses. Consider integrating PSW suggestions for additional training into curriculum. Continue to teach the Regulated Health Professions Act and related regulations. Recommendations PSNO Continue to strongly advocate for an official Ontario PSW association and stronger regulations. Consider PSW suggestions for skills upgrading courses. 4 Drifting Off Course Collins, Hogan & Piwkowski

5 Table of Contents Executive Summary... 3 Background... 7 Literature Review... 8 Purpose and Objectives Methodology and Sampling Phase 1 Student Survey Phase 2 PSW Professionals Findings: The Students Who are the students? Factors Contributing to Enrollment Role Drift Professional Responsibility Regulated Health Professions Act Findings: PSWs in the Field Who are the workers? Education What s happening in the field? Is role drift occurring? What additional training do PSWs want? Issues facing PSWs in the field PSWs thoughts on Regulation and Official Government Registry Conclusions - Students Conclusions - Professionals Recommendations Georgian College PSW Program Recommendations PSNO Future Research Considerations References Appendix A Appendix B Appendix C Drifting Off Course Collins, Hogan & Piwkowski

6 List of Figures Figure 1: Distribution of Surveys Figure 2: Student enrollment by campus/figure 3: Student age Figure 4: Average age by campus Figure 5: Why did you choose Georgian? Figure 6: Enrollment factors by age Figure 7: Enrollment factors by campus Figure 8: Awareness of role drift Figure 9: Role drift concern Figure 10: Role drift concern by age Figure 11: Comfort level with tasks untrained for Figure 12: Professional responsibility Figure 13: Awareness of Regulated Health Professions Act Figure 14: Would you perform tasks without training? Figure 15: Training and understanding of PSW tasks Figure 16: Registry, regulation and association Figure 17: How old are you?/figure 18: What is the size of the city you work in? Figure 19: Where did you receive your training/education?/figure 20: How well has your education prepared you? Figure 21: How long ago did you complete your training? Figure 22: What area of health care do you work in?/figure 23: How long have you been working as a PSW? Figure 24: PSW Tasks: Frequency vs Comfort Figure 25: What additional training do you want? Figure 26: Additional training and time as a PSW Figure 27: Issues concerning PSWs Figure 28: Issues for PSWs in Long Term Care Figure 29: Regulation of the PSW profession Drifting Off Course Collins, Hogan & Piwkowski

7 Background Mounting pressure is being placed on the Health Care system in Ontario, exacerbated by the aging of the Baby Boomer population. As a result, resources to provide quality health care are becoming increasingly strained. As a response to this mounting pressure, the Ontario Government is exploring alternative means of providing health care; examples being Home Care and Long Term Care facilities. The front line workers of these health care sectors are largely made up of Personal Support Workers (PSW). According to Health Canada there is an estimated 100,000 PSWs working in Ontario, of these, approximately 6,000 PSWs work in hospitals, 34,000 work in home care and community support and 57,000 are employed in long-term care facilities (Lum, Sladek & Ying, 2010). PSWs are responsible for providing nonprofessional services involving personal assistance to the elderly, people with disabilities or chronic health conditions (Lum et al., 2010). These activities include aspects of home management including shopping, housekeeping and meal preparation; other instrumental activities of daily living including transportation and medication management; social and recreational activities; personal care including bathing, dressing, eating and mobility (Lum et al., 2010, p.2). Increasingly PSWs are being asked to perform tasks that are beyond the scope of the traditional PSW role. Examples of these tasks include catheter care, wound dressing, venepuncture, formulating patient care plans, setting up and monitoring diagnostic machines, setting up infusion feeds and giving injections (McKenna, 2004). This is a point of concern as Personal Support Workers are unregulated health care providers who have not been properly trained to perform these tasks (Sullivan, Brown, Doyle, Mordue, Sadler-Brown & Fiddler, 2006). PSWs fall under the purview of the Regulated Health Professions Act of 1997, which defines which health care practices can be administered by which health care professionals (Lum et al., 2010). Due to a lack of regulation and standardized training there is considerable ambiguity surrounding the PSW role in health care. This trend of PSWs performing the work reserved for Registered Nurses (RN) and Registered Practical Nurses (RPN) is known as role drift (McKenna, 2004, p.411). Although it is touched upon in research on PSWs, there is a dearth of literature on the topic. As PSWs play a key role as the front line staff in Home and 7 Drifting Off Course Collins, Hogan & Piwkowski

8 Long-Term Care, it is of crucial importance to understand how this trend of role drift manifests itself within health care. Literature Review Past PSW Research Objectives Most previous research focusing on PSWs is constructed with similar objectives in mind. Since governments provide most health services to Ontarians, it is crucial for them to better understand the challenges facing PSWs. This is likely the reason that much of the previous research has been commissioned by governments and universities to provide legislators, policy makers, and health administrators with informed advice about how to address these PSW-related challenges (e.g. Carstairs & Keon, 2009; Sullivan et al., 2006; Aronson, Denton & Zeytinoglu, 2004). Other studies seek to better understand the experiences of PSWs in the field (e.g. Lum et al., 2010), and how to address the human resource challenges presenting home care organizations, particularly due to the high turnover of PSWs (e.g. Keefe, Knight, Martin-Matthews & Legare, 2010). While most studies differ slightly in the focus of their research, their goals remain consistent to better assist governments with health care planning, as it relates to PSWs in the health care sector. Past Methodological Approaches While there is a significant amount of research relating to PSWs, the overwhelming majority of research is exploratory in nature. Exploratory methods seem to be commonly utilized in PSW research when the researchers seek to understand the impact of certain government policies, or market conditions on the PSWs themselves, and segments of the PSW population (e.g. Aronson et al., 2004; Denton, Zeytinoglu, Davies & Hunter, 2006; Lum et al., 2010). While literature reviews are used as one approach in these circumstances (e.g. Keefe et al., 2010), case studies (e.g. Aronson et al., 2004; Denton et al., 2006) seem to be more commonly utilized. Exploratory methods tend to also be routinely applied in public policy documents (e.g. Carstairs & Keon, 2009; Sullivan et al., 2006). Many of these documents arrive at their conclusions through a mixture of both qualitative and quantitative processes, as well as a 8 Drifting Off Course Collins, Hogan & Piwkowski

9 reliance on health care experts. The use of surveys, public consultations, and secondary research is adopted in some of these documents (e.g. Carstairs & Keon, 2009; Keefe, Martin- Matthews & Legare, 2011), as well as jurisdictional reviews of the experiences of PSWs in other countries (e.g. Sullivan et al., 2006). The glaring lack of descriptive research on PSWs can likely be attributed to the absence of a comprehensive registry for PSWs. Fortunately, the Ontario Government is committed to establishing such a registry by 2012 ("Ontario creating registry," 2011). However, until this registry is fully operational, it is likely that this gap in PSW-related research will remain largely unaddressed. Past Sampling Approaches The sampling techniques of the various studies are also particularly noteworthy. Most of the research cited employs convenience or judgement sampling methods, and reflects the preponderance of exploratory research. Lum et al. (2010) admit that their sample is not random (and), hence, not representative of the population of PSWs. (p. 1). In the research conducted by both Denton et al. (2006) and Aronson et al. (2004), specific PSWs are targeted by the researchers; in both these studies, downsized PSWs are the focus. Aronson et al. (2004) survey 179 former workers of a particular Hamilton, Ontario home care agency. Denton et al. (2006) utilize a similar approach, although their survey is returned by 891 laidoff and current PSWs between three non-profit home care organizations in an anonymous mid-sized Ontario city. The latter study also differs in that it adds a longitudinal element PSWs were surveyed in 1996, then again in 2001 (Denton et al., 2006). While all of these studies indicate a wealth of research, additional methods and techniques could be applied to future research to better supplement and enhance previous studies. Related Problems and Challenges Role drift for PSWs can be seen as a facet of the larger problem of a lack of standardization in education and training for PSWs, which is covered extensively in the literature. Role drift for PSWs also raises the serious question of whether a high standard of care is being delivered to clients, summed up as quality assurance (McKenna, 2004, p.411). 9 Drifting Off Course Collins, Hogan & Piwkowski

10 Below, role drift will be discussed in context with education and training and quality assurance. In Ontario, attempts have been made to create some unified standardization for the education and training of PSWs, this being the Personal Support Worker Certification Program. The certification program is offered through Boards of Education, Ontario Community Colleges, Registered Private Career Colleges and not-for-profit organizations, all of which have to be approved by the Ministry of Training, Colleges and Universities (MTCU) (Keefe et al., 2010). However, there is no organization to oversee all the programs being offered throughout the province, which led to many private providers and unrecognized schools offering training that does not meet these same standards (Keefe et al., 2010, p.13). It is estimated that only 20% of the 7,000 annual graduates from PSW programs are graduating from MTCU recognized community colleges. Additionally, up until July 2011, when changes were made to the Long Term Care Act, a PSW did not need to have a PSW certificate to enter the workforce and many older PSWs did not receive any formal training at all before entering the field (Keefe et al., 2010 & Lum et al., 2010). This paves the way for serious inconsistencies in the training of skill level of PSWs in Ontario, with the threat of uneven quality of care becoming a reality. This is particularly salient given the fact that the acuity of clients in home care is increasing and in turn there have been several advancements in home care technology and due to a lack of training consistency, it is uncertain how many PSWs are being trained with the skills needed for these changes (Keefe et al., 2010). As there is not a standardized education and training program for PSWs, the scope of their role is also not communicated clearly, which leads to PSWs participating in health care activities they were not trained for. This, compounded by the unregulated nature of PSWs, raises serious issues related to quality assurance for clients (Keefe et al., 2010). Regulation and Standards One of the largest gaps identified in the background literature involves the regulations and standards of the PSW industry. Although PSWs are widely recognized as healthcare professionals, it is a largely unregulated industry. There is a small amount of regulation in the education and training of PSWs, but a lack of curriculum standardization (Carstairs & Keon, 2009). Once PSWs are in the workplace they fall under the umbrella of the Regulated Health 10 Drifting Off Course Collins, Hogan & Piwkowski

11 Professions Act (RHPA), which defines which healthcare practices can be administered by which healthcare professionals (Lum et al., 2010). However, PSWs are unregulated, making it difficult for the RHPA to clearly define what roles a PSW can fulfill (Lum et al., 2010). The lack of definitions and boundaries leads PSWs to assume tasks that they are unqualified and untrained for once they are in the workplace, often taking on responsibilities that fall under the purview of Registered Practical Nurses (RPN)(Sullivan et al., 2006). Several PSW participants of past studies expressed that a lack of provincial standards had a limiting effect on PSWs advancement opportunities and retention in the field (Keefe et al., 2011). According to the Health Professionals Regulatory Advisory Council (HPRAC)(2006), there is a blurring of roles and responsibilities between PSWs and other healthcare and service providers, and this is commonly referred to as role-drift (p.245). To combat role-drift PSW respondents from previous studies recommend a clear delineation of the duties conducted by PSWs in different healthcare settings, and a regulatory body to oversee all PSW work in Ontario (Sullivan et al., 2006). There is currently an ongoing debate in the PSW field about how the industry should be regulated. The HPRAC (2006) identifies three options, or combination of options, for the regulation of PSWs in Ontario: a regulatory body (similar to that of RNs and RPNs), certification, and a registration roster. Conclusion Despite some positive strides in recent years, Personal Support Workers face a multitude of challenges. Aside from the daily difficulties PSWs face on the job, ambiguity continues to constrain the PSW field when it comes to the regulation of job tasks. Furthermore, the lack of training standardization and a professional registry continue to leave PSWs disadvantaged relative to other health care professionals. All of these obstacles result in patients receiving lower quality care than generally required, and PSWs remaining underserviced and marginalized. While the Ontario Government has committed to the creation of a registry and has undertaken additional research relating to PSWs, more needs to be done to ensure the success of both the workers themselves, and the health care system at large. 11 Drifting Off Course Collins, Hogan & Piwkowski

12 Purpose and Objectives Purpose To explore the occurrence, extent and awareness of role drift among Georgian College PSW students and PSWs employed in Ontario. Objectives Build a demographic profile of Georgian College PSW students and professional PSWs. Determine what motivates PSW students to enroll in Georgian College over other educational institutions. Explore the level of awareness and concern PSW students and professionals have in regards to role drift. Determine the frequency PSWs carry out tasks and the level of comfort PSWs associate with those tasks. Determine potential educational gaps and recommendations for improvement. Methodology and Sampling We employed a two-phased approach for the execution of the study. The first phase consisted of a census survey of Georgian College PSW students, administered in-person. The second phase employed a convenience sample, targeting working PSW professionals through an online survey using the PSNO database. Both surveys were quantitative in nature. Phase 1 Student Survey Research Design Our initial survey consisted of a quantitative, census survey of PSW students distributed across the six Georgian College campuses that offer the PSW program. The survey was primarily designed to measure the level of awareness and concern PSW students express in regards to role drift, in addition to factors influencing their choice of Georgian for their education. 12 Drifting Off Course Collins, Hogan & Piwkowski

13 While other methods of data collection were considered - such as an online, selfadministered survey they were rejected in favour of a census survey, due to the close proximity of all six campuses. In addition, by administering the survey in-person, the research team ensured a high response rate to the request for student feedback, and ultimately a robust dataset to analyze. Data Collection Procedures and Timeline A paper-based questionnaire was designed to collect respondent data. Program co-ordinators helped facilitate survey dates to ensure optimal student attendance. Surveys were administered in-person, with at least one research team member present at every campus. The students were informed by the researchers that the research would be used to inform the PSW Program about student attitudes. Students were provided with an informed consent form to ensure confidentiality. Data collection began on Monday, January 30 at the Barrie campus, with at least one campus per week surveyed, and was completed by the beginning of March. A map of the locations of all six Georgian College campuses offering PSW coursework 13 Drifting Off Course Collins, Hogan & Piwkowski

14 Sampling Plan The PSW student roster served as the population and sample frame for the study, while individual students constituted the sampling unit. The extent of the survey consisted of all six campuses offering certificates in Personal Support Work: Barrie, Midland, Collingwood, Owen Sound, Orangeville, and Muskoka. An attempted census of the entire Georgian College PSW student population was conducted, and all students present on the day of the survey were provided a questionnaire to complete. Overall, 149 out of 188 students were surveyed, representing a 79% response rate. The results of the survey are considered accurate within ±3.67%, 19 times out of 20. The following is a breakdown of the number of surveys distributed and returned by PSW students at all six campuses: Figure 1: Distribution of Surveys Campus Semester Number of Students Enrolled Number of Surveys Received Barrie Barrie Midland Collingwood Collingwood Owen Sound Orangeville Orangeville Muskoka Muskoka Total Data Analysis Data analysis was conducted using SPSS software. Frequency distributions and crosstabs were constructed to provide an overview of the data. Data were then analyzed by groups to identify trends; age (under 22, 22-25, 26+), campus, awareness of role drift and concern about role drift were among the key trends identified. Gender was deemed to be a less prominent trend due to the abundance of females in the population. Limitations While our research team is confident in the quality of research conducted, a number of limitations were present in the methodology design, and due to circumstances outside the research team s control. A census survey proved beneficial in ensuring a more representative 14 Drifting Off Course Collins, Hogan & Piwkowski

15 picture of PSW student opinion, however, since the survey was only single-phase, a number of responses were returned by 1 st semester students. This should be considered a limitation because of their lack of exposure to the PSW curriculum and the PSW field, and should be taken into account when analyzing the results of the survey. Second, a response bias on the part of the PSW students should be considered. While there is no evidence that such a bias exists amongst the students, the survey was administered in-person, and students may have felt encouraged to provide positive feedback to the researchers, despite potentially harboring personal thoughts to the contrary. Phase 2 PSW Professionals Research Design Phase 2 of the study consisted of an online, quantitative survey exploring PSW professionals opinions and awareness of role drift, as well as their experiences with tasks relating to this issue. Responses were drawn from members of the Personal Support Network of Ontario s (PSNO) listserv database. While other advocacy groups were approached to distribute the survey, the PSNO was one of the few organizations willing and able to accommodate such a request. Due to the difficulty obtaining greater access to PSWs, as well as comprehensive demographic information, the results are considered non-representative, and should be approached with caution. Sampling Plan The survey employed a convenience sample to gather feedback from PSW professionals. The target population for our study was PSWs who were members of the PSNO at the time of survey deployment. The PSNO s listserv database served as the sample frame for the study, and individual PSWs were considered the sampling unit. Members residing across the province of Ontario were surveyed. There were approximately 3600 members of the PSNO at the outset of the study, but only 750 were accessible through the listserv. In total, 86 responses were received from current PSWs, however, only 66 responses can be considered valid, since current employment was considered a requirement. Overall, the 15 Drifting Off Course Collins, Hogan & Piwkowski

16 survey garnered a 9% response rate. Due to the lack of publically accessible demographic information on PSWs, the survey cannot be considered representative of the PSW population in Ontario. Data Collection Procedures and Timeline An online survey was created and developed using Survey Monkey software and deployed to respondents via an online link. The link was ed to PSNO listserv members on February 7, 2012 by a PSNO representative. A survey notice was distributed to potential respondents prior to deployment of the survey, and a reminder was sent two weeks after to encourage greater response. After being accessible for just over a month, the survey link was closed on March 20, Data Analysis Results were analyzed using SPSS software. Frequency distributions and crosstabs were constructed to provide an overview of the data. Data were then analyzed by groups to identify trends; city size, age, education type, and time employed were prominent trends considered. A GAP analysis was also conducted comparing frequency of tasks completed to comfort with those tasks. Limitations The most obvious limitation of the study is the non-representative nature of the data collected on PSW professionals. Since the data were collected online and through only one organization, the study may not have yielded generalizable information on working PSWs. Therefore, all results and recommendations provided on PSW professionals should be approached with caution. Second, it was difficult to assess the extent of role drift due to the vagueness of regulations. While PSWs are allowed to perform some tasks untrained and/or unsupervised under certain circumstances, a quantitative survey may not provide the necessary context that a qualitative study might yield. Finally, a low response rate and small sample size limited the ability of the study to produce greater insight into PSW trends. 16 Drifting Off Course Collins, Hogan & Piwkowski

17 Findings: The Students Who are the students? PSW students at Georgian College are overwhelmingly female, 26 and older, and in their second semester. The PSW program at Georgian College is overwhelmingly populated by women (93% female, 7% male). This is reflects the current employment trend of PSWs, who are also predominantly female. The average age of the PSW students is 31. As seen in Figure 3, slightly under half of the students are 26+ (49%), while the remainder are under 22 (29%) and (22%). Some possible reasons behind the trend of mature students in the PSW program are both voluntary and involuntary career changes. The PSW program is offered at six Georgian College campuses; Barrie, Orangeville, Collingwood, Owen Sound, Midland and Muskoka. As seen in Figure 2, the largest proportion of PSW students are enrolled at the Barrie campus (38%), which is the central and largest of the various Georgian College campuses. The Orangeville campus has the second highest proportion of PSW students (19%). The campus with the smallest proportion of PSW students is Muskoka (8%), with the remainder of students spread out relatively evenly between the Collingwood (14%), Owen Sound (13%) and Midland (13%) campuses. Figure 2: Student enrollment by campus Barrie campus has the largest population(n=149) Figure 3: Student age Almost Half of students over 25 (n=144) 8% 13% 38% 13% 14% 19% Barrie Orangeville Collingwood Owen Sound Midland Muskoka 49% 29% 22% Under Barrie campus has the largest population, Muskoka has the smallest Almost half of students are older than 25, average age Drifting Off Course Collins, Hogan & Piwkowski

18 The majority of PSW students were in their second semester at the time of the survey (59%). The differences between the number of students in first and second semester is attributed to program differences among the campuses. The Barrie, Orangeville, Collingwood and Muskoka campuses offer intake during the fall and winter, facilitating two cohorts of students per year. The Owen Sound and Midland campuses only teach one cohort per year, with intake occurring during the fall. There are also some age discrepancies among the Georgian College campuses, as seen in Figure 4. The Orangeville, Muskoka and Midland campuses have the highest average ages, 37, 38 and 39 respectively. The Collingwood campus has a slightly lower average age, 31, while the Barrie and Owen Sound campuses have the lowest average ages, 27 and 23 respectively. Figure 4: Average age by campus Midland, Muskoka, and Orangeville oldest campuses (n=149) Owen Sound 23 Barrie 27 Collingwood 31 Orangeville Muskoka Midland Age Midland campus has the highest average age (39); Owen Sound has the lowest average age (23) Factors Contributing to Enrollment The largest contributing factors to choosing Georgian College are distance and program/college reputation ; however students in different age groups often indicated different factors. The PSW students were asked to indicate which factors influenced their decision to attend the PSW program at Georgian College. When the results of the entire student population are viewed in Figure 5, distance (54%) and program/college reputation (44%) were indicated most often. The factors indicated the least overall were cost (14%) and academic/employment support (17%). However, there are some interesting differences 18 Drifting Off Course Collins, Hogan & Piwkowski

19 when the factors contributing to enrollment were compared between the different age groups (under 22, 22-25, 26+), as seen in Figure 6. Students 26+ and students under 22 both selected more factors than students in almost every category. Although academic/employment support was indicated relatively low overall (17%), it was the largest contributing factor for students 26+. The factor contributing to enrollment selected least often by PSW students 26+ was cost (37%). The most frequently selected factor by PSW students was program length (27%), while the least often selected was academic/employment support (13%), in stark contrast to PSW students 26+. The most frequently selected factor for PSW students under 22 was cost (47%), while the least frequently selected factor was also academic/employment support (21%). The disparity between the number of factors selected by older and younger PSW students illustrated that older PSW students are more likely to have a larger variety of needs to be met. This is likely due to the fact that older students are far more likely to be financially independent and have greater responsibilities, such as children, in their personal lives. Figure 5: Why did you choose Georgian? Distance and Reputation most influence enrollment (n=149) Distance Program/college reputation Program length work placement academic/employment support Other (please specify) Cost 44% 54% 0% 10% 20% 30% 40% 50% 60% Overall, distance was indicated most frequently, while cost was indicated least frequently 19 Drifting Off Course Collins, Hogan & Piwkowski

20 Figure 6: Enrollment factors by age Different factors influence each age group (n=144) Distance Cost Program Length Work Placement Program/College Reputation Academic /Employment Support Other Under 22 0% 10% 20% 30% 40% 50% 60% 70% 80% Academic/employment support indicated most frequently by students 26+, program length by students 22-25, cost by students under 22 In addition to selecting the factors contributing to their choice of Georgian College, students were also given the option to indicate factors not listed on the survey. Some of the most common factors included in the other category were; getting into a nursing program, career change, Red Cross sponsorship, job availability, employee sponsorship, small class sizes, and ministry sponsorship. PSW Students 26+ selected the other category more frequently than PSW students and under 22, once again indicating the possibility of voluntary or involuntary career change. In addition to analyzing the factors contributing to enrollment by age group, they were also analyzed by campus, as seen in Figure 7. Distance was indicated as an important factor contributing to enrollment by all campuses except Barrie, program length was indicated highest by the students at the Collingwood and Owen Sound campuses, and program/college reputation was indicated highest by students from the Barrie, Midland and Collingwood campuses. There was a significant difference between the Barrie and Midland campuses compared to the Owen Sound and Orangeville campuses for program/college reputation (p<0.05), indicating that program/college reputation is viewed as more important by PSW students enrolled at the Barrie and Midland campuses. 20 Drifting Off Course Collins, Hogan & Piwkowski

21 Factor Figure 7: Enrollment factors by campus Barrie Collingwood Muskoka Owen Sound Midland Orangeville Distance 35% 67% 75% 68% 67% 61% Cost 11% 19% 8% 21% 8% 18% Length 30% 62% 25% 47% 17% 29% Placement 32% 52% 42% 32% 8% 14% Reputation 60% 48% 17% 16% 75% 25% Student Support 16% 19% 17% 26% 17% 14% Other 18% 5% 42% 16% 8% 21% There is some disparity among factors contributing to enrollment between campuses; distance, length and reputation. Role Drift Overall there was a high degree of role drift awareness with the exception of PSW students at the Muskoka campus. Older students were more likely to be concerned and the majority would not perform a task they had not been trained for. Students were asked a variety of questions related to the trend of role drift in the PSW profession. As seen in Figure 8, the majority of PSW students were aware of role drift (78%). This trend was present throughout all of the Georgian College campuses with the exception of Muskoka, where the students were divided (50% yes, 50% no) between awareness of role drift. This is an area of concern for the Georgian College PSW program, indicating that awareness of role drift should be increased at this campus. Figure 8: Awareness of role drift Muskoka less aware of role drift (n=149) Collingwood Barrie Midland Orangeville Owen Sound Muskoka 50% 50% 0% 20% 40% 60% 80% 100% No Yes Students at every campus except Muskoka, are very aware of role drift 21 Drifting Off Course Collins, Hogan & Piwkowski

22 The PSW students who responded that they were aware of role drift were then asked to rate their concern about role drift in the PSW industry based on a four-point scale, ranging from very concerned to not at all concerned. As seen in Figure 9, approximately 18% indicated that they were very concerned and 21% indicated that they were concerned about the trend of role drift, and an additional 44% indicated that they were somewhat concerned. Although there was a high overall level of role drift concern, when analyzed by age groups, seen in Figure 10, it was found that PSW students 26+ and were more concerned about the trend of role drift than students under % of PSW students aged 26+ and 42% of PSW students aged were either very concerned or concerned about role drift, compared to only 30.3% of PSW students aged under 22. PSW students under 22 reported not at all concerned most frequently. Figure 9: Role drift concern Students moderately concerned about role drift (n=117) very concerned concerned 18% 21% somewhat concerned 44% Not at all concerned 17% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% While many students are concerned with role drift, their degree of concern varies, most being somewhat concerned Figure 10: Role drift concern by age Older students more concerned about role drift (n=117) Very Concerned Concerned Somewhat Concenned Under 22 Not Concerned 0% 10% 20% 30% 40% 50% 60% Older students seem to be more concerned about role drift 22 Drifting Off Course Collins, Hogan & Piwkowski

23 When PSW students were asked about their comfort level when performing tasks that they had not properly been trained for, using a five-point scale ranging from very uncomfortable to very comfortable, 46% indicated that they would be very uncomfortable and 39% indicated that they would be uncomfortable, as seen in Figure 11. However, there are some tasks that fall into a grey area, which may not have been taught thoroughly in the classroom, but are acceptable to perform if under the appropriate supervision. Figure 11: Comfort level with tasks untrained for Most 'very uncomfortable' perform tasks without training (n=148) very uncomfortable 46% uncomfortable 39% neither 7% comfortable 2% very comfortable 6% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% The majority of students feel uncomfortable about performing tasks for which they have not been trained Professional Responsibility PSW students feel most professional responsibility in regards to doing only tasks for which they received proper training, performing tasks at the request of care recipients, and performing tasks at the request of their employers. PSW students were presented with a series of questions asking them to rate the importance of responsibility towards different parties based on a four-point scale, ranging from very important to not important ; doing only the tasks for which you have been properly trained, doing what care recipients ask of you, doing what your employer asks of you, using your own judgement to decide which tasks to perform, and doing what family members of care recipients ask of you. As seen in Figure 12, the vast majority of PSW students 23 Drifting Off Course Collins, Hogan & Piwkowski

24 (94%) responded that only performing tasks which they had been properly trained for was either important or very important. PSW students also reported that doing what care recipients asked was of high importance. These trends show a possible resistance to performing tasks that are outside of the normal scope of PSWs. Figure 12: Professional responsibility Doing only the tasks for which you have been properly trained. 72% 22% Doing what care recipients ask of you. Doing what your employer asks of you. Using your own judgement to decide which tasks to perform. Doing what family members of care recipients ask of you. 61% 56% 47% 31% 43% 37% 36% 39% 13% 24% Very Important Important Somewhat Important Not Important Majority of students feel doing only tasks for which they have been properly trained is either very important or important, doing what family members of care recipients ask was rated as least important Regulated Health Professions Act PSW students are aware of the Regulated Health Professionals Act, their professional boundaries and are supportive of regulatory and advocacy related bodies and associations. PSW roles are defined by the Regulated Health Professions Act, which outlines the specific tasks that PSWs and other health professionals should and should not be doing. The PSW students were asked whether the Regulated Health Professions Act had been covered during the program, or if it would be covered later in the semester. As seen in Figure 13, the overwhelming majority (95%) of students indicated that it had been, or would be, covered. Students were also asked to state their level of agreement on a five point scale, ranging from strongly agree to strongly disagree, to the following statements; if asked I would perform a task that I had not been properly trained for, it is important that PSWs are 24 Drifting Off Course Collins, Hogan & Piwkowski

25 Figure 13: Awareness of Regulated Health Professions Act Most Students Aware of the Regulated Health Professions Act 5% Yes No 95% 95% of students aware of the Regulated Health Professions Act properly trained in all tasks they carry out, I feel I have a good understanding of the tasks a PSW should be performing on the job. As seen in Figure 14, the majority of PSW students (78%) answered that they would not perform a task they had not been properly trained for, indicating possible role drift resistance. Almost all of the PSW students also indicated that they feel it is either important that all PSWs are properly trained for the tasks they will be doing on the job (99%) and have a firm understanding of which tasks are and are not appropriate for PSWs to be performing (96%). This is a strong indicator that PSW students are gaining a comprehensive understanding of the Regulated Health Professions Act and their role, and boundaries, within the Ontario healthcare system. Figure 14: Would you perform tasks without training? If asked, I would perform a task that I had not been properly trained for. 51% 27% 14% 0% 20% 40% 60% 80% 100% Strongly Disagree Disagree Neither Agree Strongly Agree The majority of students would not perform a task for which they had not been properly trained 25 Drifting Off Course Collins, Hogan & Piwkowski

26 Figure 15: Training and understanding of PSW tasks It is important that PSWs are properly trained in all tasks they carry out. I feel I have a good understanding of the tasks a PSW should be performing on 59% 88% 38% 12% 0% 20% 40% 60% 80% 100% Strongly Agree Agree Neither Disagree Strongly Disagree Students feel that proper training and understanding of professional boundaries is important Finally, the PSW students were asked to state their level of agreement with a series of questions regarding PSW regulation and advocacy. As seen in Figure 16, the vast majority of PSW students (91%) agreed that PSWs should have a government registry, have a professional association (89%), and be a formally regulated heath profession (88%). This is a common sentiment echoed throughout the PSW industry, including PSWs currently in the field and PSW advocacy associations (PSNO) Figure 16: Registry, regulation and association 50% 41% 6% Strongly Agree Agree 50% 39% 9% Neither 52% 36% 9% 0% 20% 40% 60% 80% 100% Disagree Strongly Disagree Students overwhelmingly support regulation and professional associations 26 Drifting Off Course Collins, Hogan & Piwkowski

27 Findings: PSWs in the Field Who are the workers? PSWs in our sample are largely female, above 50 years old, with many working in smaller or mid-size cities. Our sample of PSWs was predominantly female, making up 83% of respondents, compared to just 17% being males. PSWs were also older in age, with an average age of 49. Looking at Figure 17 below, the majority of PSWs fall in the age categories of (28%) and Over 55 (27%), for a combined total of 55% of the sample being over 50 years old. Additionally, a high number of our respondents indicated they worked in smaller cities, with 42% of respondents indicating they work in a city with a population fewer than 50,000 people. Only a quarter of our sample indicated they work in larger cities with populations of over 250,000 people, as shown in Figure 18. Figure 17: How old are you? Figure 18: What is the size of the city you work in? 30% 25% 20% 15% 10% 5% 0% 13% Under 40 Mature workforce (n=60) 12% 20% 28% 27% Over 55 PSWs older, average age 49 Most PSWs working in small cities (n=60) 25% 33% 42% Majority of PSWs working in smaller or mid-size cities Under 49,999 50, , , Drifting Off Course Collins, Hogan & Piwkowski

28 Education Bulk of PSWs being educated at Public Colleges, feel they are well trained, and going back to school later in life Our survey respondents were asked if they had completed any formal training/education to become a PSW and were presented with a list of options to choose from. As demonstrated in Figure 19 below, the majority selected that they had attended a Public College for their training/education (52%). The next highest was Boards of Education (34%), and a relatively low number of PSWs had attended private career colleges (12%). Also, only 2% of respondents indicated that they had not received any training/education; a promising sign for the PSW profession that the vast majority of workers are receiving formal training. When asked to rate how their education prepared them for their role as a PSW, on a scale of 1(not well) to 5 (very well), PSWs strongly indicated that their education had prepared them well for their roles as PSWs, as shown in Figure 20, with 84% selected either a 4 or a 5. Figure 19: Where did you receive your training/education? 60% 50% 40% 30% 20% 10% 0% Most educated in public colleges (n=66) 52% Public College 12% Private Career College 34% Board of Education 2% No Training Figure 20: How well has your education prepared you? Very Well = Not Well = 1 PSWs feel well prepared (n=62) 3% 2% 11% 34% 50% 0% 20% 40% 60% Majority of PSWs being educated in Public Colleges PSWs feel education prepared them well When asked about how long ago they received their education/training, an interesting trend emerged. As Figure 21 highlights, the majority of PSWs in our sample had received their training recently, within the last 5 years, with 52% receiving their training 0-4 years ago, and 3% being currently enrolled in a PSW program. 28 Drifting Off Course Collins, Hogan & Piwkowski

29 Figure 21: How long ago did you complete your training? 60% 50% 40% 30% 20% 10% 0% 3% Currently enrolled Most PSW completed their education recently (n=62) 52% 21% 19% 2% 3% 0-4 years 5-9 years years years 20+ years Majority of PSWs completed their training in the last 5 years; very few trained more than 15 years ago Given that the average age of PSWs in our sample was 49, it is interesting to see that the majority have been educated relatively recently, within the last 5 years. This could point to a trend of people choosing the PSW profession as a second career. What s happening in the field? Majority of PSWs in our sample working in either Home Care or Long Term Care, with under 5 years of experience Respondents were asked what area of health care they worked in, the bulk of respondents selected that they work in Home Care (56%) with the next highest being Long Term Care (37%), shown in Figure 22. This is in line with our literature review research, where it was stated that PSWs are heavily utilized in these sectors of the health care industry (Lum, Sladek & Ying, 2010). Building on the trend of PSWs being educated later in life, a large number of our respondents had recently entered the workforce, with 51% working as a PSW for 5 years or less, shown in Figure 23. This is indicative of an older, yet less experienced workforce, as PSWs from our sample are being educated and entering the PSW field later in life. 29 Drifting Off Course Collins, Hogan & Piwkowski

30 Figure 22: What area of health care do you work in? Most working in Home Care and Long Term Care Figure 23: How long have you been working as a PSW? Most PSWs have under 16 years expirence 5% 3% Home Care Under 1 year 1-5 years 8% 43% 37% 56% Long Term Care Facility Hospital Hospice 6-10 years years years 21+ years 8% 8% 16% 18% 0% 20% 40% 60% PSWs working in Home and Long Term Care Over half of PSWs with 5 years or less experience Is role drift occurring? Yes and no We also wanted to know what tasks PSWs were performing, how frequently they were performing these tasks and what their comfort level was for the respective tasks. To ascertain this, respondents were asked to rate the frequency they perform given tasks, from never to rarely; and then they were asked to rate their comfort level with these tasks, from very uncomfortable to very comfortable. The tasks presented were a mix of those commonly associated with the traditional role of a PSW and tasks that had been identified in prior research as those associated with role drift. We conducted a gap analysis to explore the trend of role drift within our sample, the results of which are illustrated below in Figure 24: 30 Drifting Off Course Collins, Hogan & Piwkowski

31 Figure 24: PSW Tasks: Frequency vs. Comfort 4.0 Meal Preparation/Feeding Giving Injections House Cleaning/Laundry Setting up and monitoring diagnostic machines Dressing Comfort Frequency Taking Blood (Venepuncture) Bathing/Personal Hygiene Catheter Care Wound Dressing Toileting Setting up patient care plans Medication Management Setting up infusion feeds Moving and positioning patients (n=66) Respondents comfortable performing traditional PSW tasks; role drift occurring, but infrequently Our respondents demonstrated a high frequency and high comfort level with tasks associated with the traditional PSW role; these being: meal preparation/feeding, toileting, dressing, moving and positioning patients and house cleaning and laundry. However, there is some evidence that suggests role drift is occurring within our sample. Catheter care, a task outside of PSWs normal duties, rates reasonably high on frequency; however, it rates high on comfort as well. Setting up patient care plans, medication management and wound dressing are also tasks that fall outside a PSW s typical role, but, they are being performed somewhat less frequently than catheter care and have a reasonably high level of comfort associated with them. Although the tasks of venepuncture, giving injections, setting up infusion feeds and setting up and monitoring diagnostic machines are performed infrequently, there is a very low level of comfort associated with these tasks, and could be an area of concern for PSWs. Thus, there is evidence of role drift occurring within our sample, however, the scale of it seems to 31 Drifting Off Course Collins, Hogan & Piwkowski

32 be limited, and we are unable to tell to what degree they have been trained for these tasks and if they are done under supervision. What additional training do PSWs want? Strong desire for additional training, especially in mental health issues and chronic disease management, differences exist by time in field We asked PSWs what additional training they felt would help them do their job better, and presenting them with a list based on prior research, asked them to select all those that applied. Figure 25 below shows the results, the percentages represent the number of respondents who selected that the training would benefit them. There is a strong want for additional training for PSWs, in particular for training on: mental health issues (72%), chronic disease management (60%), palliative care (55%), dealing with family members (52%), medication management (45%) and disabilities (45%). Figure 25: What additional training do you want? Stong desire for additional training (n=66) Mental Health Issues Chronic Disease Management Palliative Care (Pain Management) Dealing with Family Memembers Medication Management Disabilities Elder Abuse Addressing Traditions for Diversity Infection Control Occupation Health and Safety None 3% 20% 32% 30% 28% 60% 55% 52% 45% 45% 72% 0% 20% 40% 60% 80% 100% PSWs want additional training, particularly with mental health issues, chronic disease management, palliative care, dealing with family members and medication management When we recoded time working as a PSW into two categories, under 5 years and over 5 years, significant differences did emerge between the two groups, as Figure 26 highlights: 32 Drifting Off Course Collins, Hogan & Piwkowski

33 Figure 26: Additional training and time as a PSW Additional training differs by age Medication Management Addressing Traditions for Diversity Chronic Disease Management Dealing with Family Memembers Occupation Health and Safety Infection Control Mental Health Issues Palliative Care (Pain Management) Disabilities Elder Abuse 33% 37% 67% 63% 37% 63% 0% 20% 40% 60% 80% 100% More than 5 years Under 5 Years n=32 n=31 What additional PSWs want differs by time in field, with medication management, disabilities and elder abuse showing significant differences The significant differences were in medication management, with a higher degree of PSWs in the field for more than 5 years (67%) selecting this additional training compared to those in the field for under 5 years (33%)(p<0.05). Also, additional training with disabilities and elder abuse was strongly favoured by PSWs in the field for less than 5 years (63%) compared to those with over 5 years experience (37%)(p<0.05). Issues facing PSWs in the field Being overworked, unpredictable schedules and differences among training programs concerning to PSWs; role drift a concern in Long Term Care We asked our respondents what issues they were concerned about as a PSW. We presented them with a list of issues that are common in the PSW profession, and had them rate their level of concern on a scale from not concerning to very concerning. Looking at Figure 27, the three most concerning issues to PSWs are being overworked, with 38% finding this very concerning and 22% finding it concerning; unpredictable schedules, with 37% finding this very concerning, and 23% saying this was concerning; differences among training 33 Drifting Off Course Collins, Hogan & Piwkowski

34 problems also resonated with PSWs, with 31% indicating this was very concerning, and 28% saying this was concerning. The first two issues, being overworked and unpredictable schedules, speak to the nature of PSW work, which as we found in our literature review, is largely characterized by PSWs working long hours and having to piece together a full-time job. The issue of differences among training programs speaks to a lack of regulation within the PSW profession, which could lead to PSWs entering the field with different levels of knowledge for the role. Figure 27: Issues concerning PSWs Issues concerning PSWs Being overworked 38% 22% 23% n=60 Unpredictable schedules 37% 23% 32% n=58 Differences among training programs 31% 28% 33% n=60 Workplace conflict 29% 22% 27% n=59 Pressure to perform job tasks outside normal role n=60 28% 25% 25% Lack of strict workplace regulations 22% 30% 27% n=60 Very concerning Concerning Somewhat concerning Not Concerning 17% 8% 9% 22% 22% 22% Being overworked, unpredictable schedules and differences among training programs rate high in concern for PSWs When looking at issues of concern to PSWs by area of health care, some interesting trends emerged, in particular with PSWs working in Long Term Care, highlighted below in Figure 28: 34 Drifting Off Course Collins, Hogan & Piwkowski

35 Figure 28: Issues for PSWs in Long Term Care Issues for PSWs in Long Term Care Being overworked 65% 15% 5% 15% n=20 Differences among training programs 37% 21% 42% n=19 Pressure to perform job tasks outside normal 35% 45% 5% 15% n=20 Unpredictable schedules 35% 35% 25% 5% n=20 Workplace conflict 35% 35% 10% 20% n=20 Lack of strict workplace regulations 25% 40% 20% 15% n=20 Very concerning Concerning Somewhat concerning Not Concerning Role drift a concern in Long Term Care Aside from strongly indicating that being overworked is a concern, the majority of PSWs working in Long Term Care expressed that pressure to perform tasks outside normal role was a concern, with 35% indicating it was very concerning and 45% saying it was concerning. This suggests that among PSWs working in Long Term Care in our sample, that role drift is a strong concern and may be occurring. PSWs thoughts on Regulation and Official Government Registry PSWs strongly agree with more regulation of profession We asked our respondents their opinion on a number of questions relating to more regulation of the PSW profession, the results of which are shown in Figure 29: 35 Drifting Off Course Collins, Hogan & Piwkowski

36 Figure 29: Regulation of the PSW profession PSWs stongly agree with more regualtion for the profession (n=60) PSWs should have a government registry 73% 12% Strongly Agree PSWs should have a professional association 77% 13% Agree Neither Disagree Strongly Disagree PSWs should be a formally regulated profession 77% 10% PSWs strongly agree with more regulation for the profession, sharing sentiment with the PSW students PSWs in our sample showed strong agreement for more regulation and standardization within the PSW profession, with 85% either strongly agreeing or agreeing that PSWs should have a government registry, 90% strongly agreed or agreed that PSWs should have a professional association, and 87% strongly agreed or agreed that PSWs should be a formally regulated profession. 36 Drifting Off Course Collins, Hogan & Piwkowski

37 Conclusions - Students Distance and Program/College reputation most important factors influencing enrollment Overall, students felt that their close proximity to a Georgian campus (54%) and the reputation of the College or the Program (44%) were the most important factors influencing their decision to enroll in the PSW Program at Georgian. Reputation was particularly important for students at the Barrie and Midland campuses, while it was considered less important at the Owen Sound and Orangeville campuses. Distance was cited as an important factor at all campuses except the Barrie campus. Additionally, older students (+26) were largely influenced by distance as well as academic support. Finally, some students stated that they chose the PSW Program as a stepping stone to a nursing career, for the availability of PSW jobs, or a career change, among other reasons. Students are highly aware of Role Drift The vast majority of students are aware of the trend of Role Drift (79%). Over threequarters of students at every campus except Owen Sound and Muskoka, affirmed their awareness of the trend. Despite these positive results, Muskoka stood out as one campus of concern, with only 50% of students signalling their knowledge of role drift. Students are only moderately concerned about Role Drift Only 31% of students were very concerned or concerned about role drift. However, older students (>22) tended to be more concerned about Role Drift than younger students (<22). But, they are uncomfortable performing tasks untrained The overwhelming majority of students (85%) indicated they would feel very uncomfortable or uncomfortable performing a task they were not trained for. Many students declaring only moderate or no concern about role drift also indicated their discomfort with performing tasks untrained. 37 Drifting Off Course Collins, Hogan & Piwkowski

38 Students are well informed about regulations 95% of students responded that their teachers have informed them - or have indicated that they will - about the Regulated Health Professions Act. Students overwhelmingly affirmed that they would not perform a task that they had not been trained for (78% strongly disagree or disagree ). Students felt that PSWs should be properly trained in all tasks they complete, and that they have a good understanding of the tasks a PSW should be performing. Students strongly support more standardization of the PSW profession More than 90% of students strongly agreed or agreed that PSWs should be a formally regulated profession, and more than 80% of students believe that PSWs should have a government registry and see the establishment of a professional association. Conclusions - Professionals Role Drift is occurring, but It is difficult to ascertain to what degree. Professionals are performing tasks outside their traditional roles but not at the same rate as they perform traditional PSW tasks. Additionally, it is difficult to determine whether or not PSWs are performing these tasks untrained or unsupervised. PSWs are comfortable with most tasks they complete PSWs responded that they are comfortable with traditional PSW tasks. They are less comfortable with role drift tasks, but these tasks are performed infrequently. This suggests that PSWs are receiving adequate training for tasks within their role domain. Most PSWs trained at public institutions Most PSWs polled were trained at public institutions (52% at public colleges & 34% at school boards vs. only 12% at private career colleges). PSWs also felt that overall their education did prepare them well for the job (84% very well or well ). Responses were similar for PSWs trained at both private and public institutions. These results are positive for 38 Drifting Off Course Collins, Hogan & Piwkowski

39 both professionals and educators, and suggest that overall the industry is effectively training its workers. PSWs typically begin training at an older age than the average student The average PSW is 48 years old but a majority completed their education within the last 4 years. Just over half have also been working for only the past 0-5 years. This could potentially be due to PSWs entering the profession as a second career. PSWs strongly desire additional training Among the options provided to respondents for additional training, mental health issues received the strongest support (72%). Chronic disease management, palliative care, dealing with family members, medication management and disability training were also frequently selected. There were also differences in additional training suggested by time in field. PSWs with more than 5 years of experience were more likely to mention medication management (67%) while PSWs with less than 5 years of experience were more likely to mention elder abuse (63%) and disability training (63%). PSWs are concerned with lack of profession standardization and heavy workload While PSWs consider their education to be of good quality, they are concerned about differences among training programs. This further reinforces concern about the lack of training standardization and regulation throughout the industry. PSWs are also concerned with the heavy workloads they face and unpredictable schedules. Additionally, over half of PSWs in Long-Term Care and almost half in Home Care frequently expressed concern about the pressure to perform tasks outside normal job role. While respondents did not consider role drift to be the most concerning aspect of their role, this reflects the moderate level of concern expressed by both students and professionals in regards to role drift. 39 Drifting Off Course Collins, Hogan & Piwkowski

40 Professionals strongly support more standardization of the PSW profession Professionals overwhelmingly support a government registry, the establishment of a professional association, and for the profession to become more formally regulated. This feedback closely aligns with student opinion and indicates solidarity among both students and workers. Recommendations Georgian College PSW Program Look beyond a one-size-fits-all approach to program promotion When promoting the program to students, we recommend that the Georgian College PSW Program should be aware of their attraction drivers. For students in the Barrie region, emphasize the reputation of the program and the college; since students have more choice for example, private, public, and non-profit certificates they are more likely to be swayed by a certificate that has a strong reputation attached to it. For prospective students at satellite campuses, emphasize the close distance to the college, as their options for education are more limited. Finally, for older students, highlight the academic/employment resources that the college offers. Consider integrating PSW suggestions for additional training into curriculum Training programs should consider including additional training/support in the areas of medication management, chronic disease management, mental health issues, palliative care and dealing with family members. Additionally, PSWs with less than 5 years of experience frequently mentioned elder abuse and disability training as areas requiring additional training, suggesting that there may be a growing need in the field for this skillset. While the Georgian College PSW Program does address many of these topics in its current curriculum, more emphasis on these topics could ensure students complete their certificate with the most upto-date training possible. 40 Drifting Off Course Collins, Hogan & Piwkowski

41 Continue to teach the Regulated Health Professions Act and related regulations Students have indicated a strong knowledge of the Act and this is further proof of the students awareness of role drift and related problems. We recommend that the Georgian College PSW Program continue to teach the Act and any related regulations. By staying abreast of the latest legislation and rules pertaining to PSWs, students will be better aware of their role in the health care industry, and better prepared to deliver excellent quality care to patients. Recommendations PSNO Continue to strongly advocate for an official Ontario PSW association and stronger regulations Both PSW students and professionals strongly expressed their desire for a government registry, a professional association, and for the field to be formally regulated. While the Ontario government has already committed to the establishment of such a registry, advocating on behalf of PSWs for a professional association and stronger regulations will benefit the field, by ensuring professionals are more confident about their role in the health care profession, and their training. An association and stronger regulations would also provide additional comfort to health care recipients, who can receive care fully confident that PSWs know their role. Consider PSW suggestions for upgrading skills courses PSWs expressed a strong desire for further training in mental health issues, medication management, chronic disease management, dealing with family members and diversity issues. By completing additional seminars/coursework in these topics, PSWs will be more confident in the care they provide to patients. We recommend that the PSNO consider promoting additional training for PSWs in these areas. While the PSNO may not have the capacity to offer this training in isolation, by promoting this issue, they could encourage other PSW education providers to adopt this recommendation. 41 Drifting Off Course Collins, Hogan & Piwkowski

42 Future Research Considerations Shift the focus to tasks performed untrained and/or unsupervised While this study did attempt to answer the question about whether or not role drift is occurring, it did not go far enough. By focusing on frequency and comfort of tasks performed, we were able to determine that PSWs are performing tasks outside their traditional role, but not if these tasks are being performed untrained and/or unsupervised, a key distinction. PSWs are allowed to perform non-traditional PSW tasks under certain circumstances, and future research should go further to address this concern. Strongly consider qualitative approaches Qualitative methods could provide added value to any future research conducted on PSWs. Qualitative methods could prove helpful when exploring any grey area problems related to role drift. Grey areas are particularly problematic when it comes to the determination of when a PSW is performing a task untrained and/or unsupervised. What defines training and supervision in PSW regulations? A qualitative approach may produce additional insight into the nuances of role drift. This approach would also be helpful in adding context to determining attraction drivers. While we were able to identify a number of factors influencing enrollment, focus groups or in-depth interviews could paint a more comprehensive picture of what specifically drives prospective PSW students to enroll in Georgian. Leverage the forthcoming Ontario PSW registry Finding accurate demographic data on PSW professionals was a difficult task for our research team, especially due to PSWs working for a wide variety of agencies and organizations located across the province. Accessing sample frames for any number of these organizations is especially difficult, especially due to the bureaucratic barriers to collecting PSW data. The Ontario Government is slated to open the new official PSW registry in summer Taking advantage of this resource for future research would provide a more representative and comprehensive picture of PSW trends and demographic information. 42 Drifting Off Course Collins, Hogan & Piwkowski

43 Consider including other health care professionals in future research Most health care workers do not work in silos, and many roles and tasks overlap. By including other health care workers in future quantitative and/or qualitative research, additional information about role drift could be gathered. This approach would likely provide a more comprehensive picture of trends relating to PSWs. 43 Drifting Off Course Collins, Hogan & Piwkowski

44 References Aronson, J., Denton, M., & Zeytinoglu, I. (2004). Market-modelled home care in Ontario: Deteriorating working conditions and dwindling community capacity. Canadian Public Policy, XXX(1), Carstairs, S., & Keon, W. The Senate, Special Senate Committee on Aging. (2009). Canada's Denton, M., Zeytinoglu, I., Davies, S., & Hunter, D. (2006). The impact of implementing managed competition on home care workers' turnover decisions. Healthcare Policy, 1(4), Retrieved from website: Keefe, J., Knight, L., Martin-Matthews, A., & Legare, J. (2010). Key issues in human resource planning for home support workers in Canada. WORK: A Journal of Prevention, Assessment, and Rehabilitation, 40(1), doi: /WOR Keefe, J., Martin-Matthews, A., & Legare, J. (2011). Home support workers: Human resource strategies to meet chronic care needs of Canadians. Retrieved from website: Lum, J., Sladek, J., & Ying, A. (2010). Ontario personal support workers in home and community care: Crncc/psno survey results. Toronto: Canadian Research Network for Care in the Community. McKenna, H. (2004). "Role drift" to unlicensed assistants: Risks to quality and safety. Quality & Safety in Health Care, 2004(13), doi: /qshc Ontario Government, Ministry of Health and Long-Term Care. (2011). Ontario creating registry for personal support workers. Retrieved from website: aging population: Seizing the opportunity. Retrieved from website: Sullivan, B., Brown, B., Doyle, K., Mordue, M., Sadler-Brown, P., & Fiddler, E. (2006). Regulation of health professionals in Ontario: New directions. Toronto. Retrieved from website: w_directions.pdf. 44 Drifting Off Course Collins, Hogan & Piwkowski

45 Appendix A Informed Consent Form Drifting Off Course: Examining Role-Drift Among Personal Support Workers in Ontario This consent form outlines the purposes of the study and provides a description of your involvement and rights as a participant. Introduction: The researchers are students in the postgraduate Research Analyst Program at Georgian College. This study is part of a Major Research Project being conducted by three students. Purpose: To examine the trend of role-drift within the PSW field, which is the trend of employees preforming tasks for which they have not been given any formal training or education. This is an important study because PSWs are the front line workers in healthcare and because of this, quality assurance is a pertinent issue. By better understanding how role-drift manifests itself in the PSW field we can assess opportunities for improvement in education, training and regulation. Procedure: We are looking at two sample populations; PSW students at Georgian College and members of the PSNO (Personal Support Network of Ontario). For the student population we will administer our survey in person using scan forms. For the PSNO population we will administer our survey online, using the PSNO database. Your participation in this research study is voluntary. You are under no obligation to participate in the study by signing this form. You have the right to withdraw at any point, for any reason, and without prejudice, and any information collected will be turned over to you or destroyed at that time. Confidentiality and protection of privacy: Your real name will not be used at any point of information collection or in the final report. You will be given a pseudonym that will be used in all verbal and written records and reports. Authorization: I have read and understand this consent form and I volunteer to participate in this research study. I voluntarily choose to participate, but I understand that my consent does not take away any legal rights in the case of negligence or other legal fault of anyone who is involved in this study. I further understand that nothing in this consent form is intended to replace any applicable federal, provincial, or municipal laws. 45 Drifting Off Course Collins, Hogan & Piwkowski

46 Right of refusal to participate or withdraw: Today s date is: I agree to the terms outlined above. Researcher name (print): Researcher signature: I agree to the terms outlined above. Participant name (print): Participant signature: 46 Drifting Off Course Collins, Hogan & Piwkowski